ix
Contents
Preface................................................................................................... xix
Acknowledgments from Mark Graban .................................................. xxi
Acknowledgments from Joe Swartz.....................................................xxiii
Foreword by Masaaki Imai................................................................... xxv
Introduction by Norman Bodek ......................................................... xxvii
About the Authors............................................................................... xxix
SECTION 1 WHAT IS KAIZEN?
1 Kaizen and Continuous Improvement ............................................... 3
Kaizen = Change for the Better ......................................................................... 4
Bubbles for Babies ............................................................................................. 5
Kaizen: A Powerful Word .................................................................................. 6
Kaizen Is Not Just Change, It Is Improvement .................................................. 8
We Often Succeed as the Result of Failing More ............................................. 8
Kaizen, PDSA, and the Scientific Method for Improvement ............................ 9
Changing Back Can Be Better for Babies ........................................................11
Kaizen = Continuous Improvement ................................................................ 12
Kaizen Starts with Small Changes ................................................................... 13
A Small Kaizen with Great Meaning ................................................................14
Kaizen = Engaging Everybody in Their Own Change ....................................14
Kaizen Upon Kaizen Upon Kaizen ..................................................................15
Kaizen Closes Gaps between Staff and Leaders ..............................................16
Creativity before Capital ...................................................................................17
Expensive Mistakes Made without the Kaizen Mindset ................................. 20
Kaizen and Lean: Related and Deeply Interconnected Concepts .................. 20
People Are the Ultimate Competitive Advantage............................................ 21
High-Level Kaizen Principles—The Kaizen Mindset ...................................... 21
Principle 1: Asking ................................................................................... 22
Principle 2: Empowering .......................................................................... 23
Principle 3: Recognizing ........................................................................... 23
Principle 4: Sharing .................................................................................. 23
x ◾  Contents
This Is Not a Suggestion System—It Is an Improvement System ................... 24
Kaizen Has an Impact on People and Performance
....................................... 24
Conclusion
........................................................................................................ 27
Discussion Questions
....................................................................................... 27
Endnotes
........................................................................................................... 27
2 The Roots and Evolution of Kaizen ................................................. 31
Early Suggestion Programs
...............................................................................31
Downsides of Suggestion Box Programs
........................................................ 32
Recovering from Taylorism
.............................................................................. 35
The American Roots of Continuous Improvement—TWI and Deming......... 37
Kaizen: One of the Two Pillars of The Toyota Way
....................................... 40
Masaaki Imai and the Spread of Kaizen (1986)
.............................................. 42
Dr. Donald M. Berwick’s Call for Kaizen (1989)
............................................. 44
Medicine’s Need for Kaizen” (1990)
............................................................... 45
Norman Bodek and American Kaizen
............................................................ 45
Conclusion
........................................................................................................ 46
Discussion Questions
....................................................................................... 46
Endnotes
........................................................................................................... 47
3 Types of Kaizen ............................................................................... 49
The Continuous Improvement of a Lifesaving Innovation
............................. 50
Three Levels of Kaizen
.....................................................................................51
Imai’s Three Levels of Kaizen
.................................................................. 55
Complementary Nature of the Levels of Kaizen
..................................... 55
Three Types of Kaizen at Childrens Medical Center Dallas
.................. 56
Events Alone Will Not Make You Lean
........................................................... 57
The Origins of Kaizen Events
.................................................................. 57
Basic Structure and Format of an Improvement Event
........................... 58
Additional Challenges with Weeklong Events
......................................... 59
Impressive Results from Kaizen in Healthcare
........................................ 60
Virginia Mason Medical Center
........................................................ 60
ThedaCare
......................................................................................... 62
Not All Kaizen Organizations Use Events
............................................... 64
Avera McKennan Uses System Kaizen and Daily Kaizen
....................... 64
Kaizen Leads to Innovation at Franciscan
............................................... 65
Conclusion
........................................................................................................ 66
Discussion Questions
........................................................................................67
Endnotes
............................................................................................................67
4 Moving Toward a Kaizen Culture .................................................... 71
The Real Goal—Cultural Transformation........................................................ 71
What a Kaizen Culture Feels Like
................................................................... 73
Everyone Is Engaged
................................................................................ 73
Drivers of Engagement
..................................................................... 75
Contents ◾  xi
Everyone Is Relentlessly Searching for Opportunities to Improve ......... 76
The Two Parents of Transformation: Pain and Possibility
...................... 78
Pain
................................................................................................... 78
Possibilities
........................................................................................ 79
You Have Control over Your Workplace
................................................. 80
Patients and Families Are Happy
............................................................. 81
Staff and Physicians Are Happy
............................................................... 84
Work and Patient Care Flow Like Clockwork
......................................... 86
The Workspace Is Clean, Orderly, and Safe
............................................ 86
Everyone Works Together
........................................................................ 87
Everything Gets Questioned
.................................................................... 90
Small Successes Lead to Bigger Successes
.............................................. 90
Imai’s Three Stages of Kaizen
......................................................................... 93
Conclusion
........................................................................................................ 94
Discussion Questions
....................................................................................... 94
Endnotes
........................................................................................................... 95
SECTION 2 KAIZEN METHODOLOGIES
5 Quick and Easy Kaizen.................................................................... 99
How to Do Kaizen
........................................................................................... 99
Quick and Easy Kaizen
................................................................................. 100
Starting the Franciscan Kaizen Journey
.........................................................102
The Quick and Easy Kaizen Process
.............................................................102
Step 1—Find
............................................................................................103
Start Small
........................................................................................103
Start with You
..................................................................................103
Make Your Work Easier
...................................................................103
Make Your Work Safer
.....................................................................105
Make Your Work More Interesting
..................................................105
Build Your Skills, Your Capabilities, and Your Knowledge
.......... 106
See an Opportunity or a Problem
................................................. 106
Step 2—Discuss
.......................................................................................112
Discuss with Your Direct Supervisor
..............................................112
Discuss with Your Team Members
.................................................115
Step 3Implement
.................................................................................123
Enrolling Others to Help
.................................................................123
Implement the Improvement Idea
..................................................124
Seven Days Grace
............................................................................124
Step 4—Document
..................................................................................125
Finalize the Kaizen Report
............................................................. 126
Submit Report for Approval
............................................................129
Step 5Share
......................................................................................... 130
Leveraging Improvement Ideas from Others
................................. 130
Sharing Kaizens
...............................................................................131

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